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Community Based Cardiovascular Improvements: Translating Knowledge into Outcomes CARMEN– October, 2004

Community Based Cardiovascular Improvements: Translating Knowledge into Outcomes CARMEN– October, 2004. Richard J. Schuster, M.D., M.M.M. Boonshoft Chair and Director NHLBI EDUC Center of Excellence. Enhanced Dissemination Utilization Center (EDUC).

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Community Based Cardiovascular Improvements: Translating Knowledge into Outcomes CARMEN– October, 2004

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  1. Community Based Cardiovascular Improvements:Translating Knowledge into OutcomesCARMEN– October, 2004 Richard J. Schuster, M.D., M.M.M. Boonshoft Chair and Director NHLBI EDUC Center of Excellence

  2. Enhanced Dissemination Utilization Center(EDUC) • This project has been funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health under contract number N01-HO-29235

  3. CARMEN to Wright State

  4. Why Focus on “Translation” • We have failed! • Practitioner knowledge is good • Practitioner practice is poor • How Poor? * • How many of your hypertensives do you believe are under control: 50 - 60% • How many of your hypertensives are actually under control: 25% *Oliveria, et. al., Arch Intern Med. 2002 Feb 25;162(4):413-20.

  5. Why Focus on “Translation” • We have failed! • We know what to do • The public receives mediocre care in the US • How Poor? • Only 31% hypertensives in the US are under control 1 • Only 35% of people with high cholesterol know their condition 2 1 NHANES 1999-2000, Hajjar, JAMA, 2003, 290(22):199. 2 NHANES 1999-2000, Ford, Circulation, 2003, 107(17):2185.

  6. Physician Behavior Change“Eisenberg’s Rules” *** • Education [Grand Rounds] • Administrative Changes [“Hassles”] • Participation • Financial Incentives • Rewards • Penalties • Feedback *** Nash, David, “Three Faces of Quality,” ACPE

  7. Getting the Numbers Better The Hawthorne Effect?

  8. Getting the Numbers Better:Beyond The Hawthorne Effect • Show doctors their numbers • Review Guidelines • Give them expectations • Show them the numbers again

  9. Cholesterol Management in Patients with Coronary Artery Disease Program • Target Population: Coronary Artery Disease Patients • Program: Physicians receive clinical outcomes • Program: Patients receive • Personally signed letter from their physician giving them a target LDL cholesterol • NHLBI produced reading material • Wallet card to record their “metabolic syndrome” number • Follow-up phone call

  10. LDL Levels (ATP III Guidelines) 60% Baseline Intervention 51% Follow up Intervention 40% 31% 30% 23% 20% 20% 12% 11% 6% 3% 1% 0.4% 0.5% 0% Optimal Near Borderline High (160- Very High Missing (<100) Optimal (100- High (130- 189) (>=190) 129) 139) Outcomes 105 Physician Primary Care Group

  11. P<0.05

  12. Hypertension - Obesity Management Program • Target Population: African American & Appalachian Populations • Program: • Physicians receive feedback on their clinical performance • Physicians measure waist size as a “vital sign” during visits of hypertensive patients

  13. Baseline (n=145) Follow-up (n=203) Mean Blood Pressure Levels at Baseline and at 1 Year Follow-up 145 136 150 Urban Health Centers 78 78 100 50 p=0.001 0 Systolic Diastolic

  14. Baseline (n=145) Follow-up (n=203) LDL Levels Based on ATP III Guidelines 29% 29% 30% 27% 25% 25% 21% 19% 20% 17% 15% 12% 10% 10% 5% 3% 3% 5% p=0.15 p=0.21 0% Optimal Near Optimal Borderline High (160-189) Very High Missing High (130-159) (<100) (100-129) (>/=190)

  15. Mass Media: Social Marketing Educate the Public (Just Like the Drug Companies)

  16. Know Your Numbers • Project type: Mass Media Social Marketing Campaign • Entering 4th Year • $600,000 Campaign • Outcomes: • African American Middle-aged women - Early effect • Middle-aged women - Effect • General population – Late effect

  17. Do You Know Your Cholesterol Numbers? 14% increase 40% 40% 38% 35% 34% 36% 34% 32% 30% Baseline 6 month 12 month 14% increase in the number of women who know their cholesterol numbers. p=.191 between baseline and 12 month.

  18. Did Seeing the KYN Commercial Prompt You to Have Your Blood Pressure or Cholesterol Checked? 85% increase p=0.019 23% 20% 13% 10% 0% years- W 1 year- W 2 12,711 middle-aged womenhad either their cholesterol or BP checked in 2 years from the KYN campaign

  19. Physician Obesity Awareness Program Program • Physicians identify obesity as a CV risk factor • Routinely record the recommendation to lose weight in the medical record using a sticker in the body of the medical record

  20. How Comfortable are Physicians in Discussing Obesity with their Patients ?

  21. Have Physicians Responded? Early Report

  22. Community Based Cardiovascular Improvements:Translating Knowledge into OutcomesCARMEN– October, 2004 Richard J. Schuster, M.D., M.M.M. Boonshoft Chair and Director NHLBI EDUC Center of Excellence

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